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Luis A. Alvarez, MD; Richard B. Lipton, MD; Alan Hirschfeld, MD; Oskar Salamon; George Lantos, MD

Arch Neurol. 1988;45(2):225-227.

Abstract
• The absence of cerebral blood flow is presently considered the most reliable ancillary test in diagnosing brain death. A patient with an open skull fracture who met all criteria for brain death, including confirmatory postmortem studies, had a cerebral angiogram that showed unilateral preservation of cerebral circulation with diffuse extravasation of contrast material. We conclude that a skull defect may result in pressure reduction within the cranial cavity and persistent ipsilateral cerebral circulation, even after brain death. In this setting, diffuse extravasation of contrast material on angiography may reflect diffuse autolysis and suggest the diagnosis of brain death.

Author Affiliations
From the Departments of Neurology (Drs Alvarez and Lipton), Neurosurgery (Dr Hirschfeld), and Radiology (Dr Lantos and Mr Salamon), Bronx Municipal Hospital Center, Albert Einstein College of Medicine, New York.

Footnotes
Accepted for publication July 8, 1987.

Reprint requests to Department of Neurology, Albert Einstein College of Medicine, Building F, G-9, 1300 Morris Park Ave, Bronx, NY (Dr Lipton).

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